New research shows a statistical significant association between increased LARC usage and reduction in teenage pregnancy and abortion rates in England
New findings, published in the International Journal of Women’s Health, show increased long-acting reversible contraception (LARC) usage in England was significantly associated with decreased teenage pregnancy rates (under 18 years) and abortion rates in women aged under 20 years.[i]
The research, commissioned by Merck Sharp & Dohme Limited (MSD), found that:
- Under-18 conception rates decreased significantly between 1998 and 2011, from 46.6 to 30.7 per 1,000 women.[i] A statistically significant association was observed between this decrease and increased LARC usage [i]
- Abortion rates in younger women (below 20 years of age) decreased between 1998 and 2011 and their association with increased LARC usage in this age group was statistically significant i
- The trend of LARC usage observed over the entire 1998-2011 period was an 89.7% increase [i]
- There was also evidence of increased LARC usage following the positive NICE clinical guidance which reinforced the cost effectiveness of LARC methods.[i]
In addition to increased LARC usage, the 1999 Teenage Pregnancy Strategy is likely to have significantly contributed to the reduction in teenage conceptions over the 13-year study period (1998-2011). The strategy aimed to reduce the rate of teenage conceptions with the specific aim of halving the rate of conceptions among under-18s, and to set a firmly established downward trend in the rate of conceptions among under-16s, by 2010. It also improved the awareness of and provided access to all choices of contraception. However, the recent reforms to improve healthcare provision, that moved the provision of LARC into the public health domain, have posed some challenges for providers.
Lead author Dr Anne Connolly, GP/Clinical Lead for Maternity, women’s and sexual health, Bradford and Chair of the Primary Care Women’s Health Forum comments: “These findings are interesting because they demonstrate that the use of LARC can make a significant impact to the rate of unplanned pregnancies. There are also US data to show that when women have full information about available contraceptive methods, many will choose intrauterine devices or implants.[ii] LARC methods have proven efficacy and there is strong evidence to demonstrate the economic benefits resulting from the use of these methods from both a health and social care point of view.”
She continued: “However, Primary Care Women’s Health Forum members are concerned about the future of sexual health services because of the recent commissioning changes which are putting funding for maintaining these services in both the community and in primary care settings at risk. Access in particular is key to ensure women are able to get LARC methods. If access to these contraceptive methods were to be reduced, vulnerable women may opt for more accessible and less effective methods.”
[i] Connolly, A. et al Evaluation of long-acting reversible contraceptive use, teenage pregnancy and abortion rates in England – is there an association? International Journal of Women’s Health 2014;6:961-974.
[ii] Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;11:115. e1-115.e7.
[iii] Quarterly Conceptions to Women Aged Under 18, England and Wales, Q2 2013. Available at http://www.ons.gov.uk/ons/rel/vsob1/quart-conc-to-women-und-18/q2-2013/index.html Last accessed August 2014.
[iv] WHO European health for all database (HFA-DB) World Health Organization Regional Office for Europe Updated: July 2013. Available at http://data.euro.who.int/hfadb/ Last accessed March 2014.
[v] Avery L, Lazdane G. What do we know about sexual and contraceptive health of adolescents in Europe? Eur J Contracept Reprod Health Care 2010; 15(S2): S54–S66.
[vi] Unprotected Nation The Financial and Economic Impacts of Restricted Contraceptive and Sexual Health Services A Report by Development Economics. Commissioned by FPA and Brook January 2013.
[vii] Department of Health: A Framework for Sexual Health Improvement in England. Published 15 March 2013.
[viii] The Morning After: A cross party inquiry into unplanned pregnancy. February 2013. 2020 health.org, funded by MSD. http://www.2020health.org/dms/2020health/downloads/reports/2020UNPREGnew_FINAL.pdf.
[ix] Pfizer, Depo-Provera, Summary of Product Characteristics 18 September 2012.
[x] Pfizer, Sayana Press, Summary of Product Characteristics 24 September 2012.
[xi] MSD, Nexplanon, Summary of Product Characteristics 29 November 2013.
[xii] FPA, Your guide to the IUD. November 2012.
[xiii] Bayer, Mirena, Summary of Product Characteristics 3 June 2012.
[xiv] Bayer, Jaydess, Summary of Product Characteristics 3 April 2014.